title: Surgical excision of large multinodular goiter using an endoscopic transaxillary approach: a case report.
abstract: BACKGROUND
  Minimal access surgery for thyroid and parathyroid disease has gained increasing popularity due to excellent endoscopic visualization and overall cosmetic outcome. Most current techniques limit the size of the gland that can be removed to less than 4 cm. Patients with multinodular goiter with gland size greater than 4 cm commonly present for surgical therapy. We evaluated the use of an endoscopic transaxillary approach for the treatment of large multinodular goiters. We herein present a case report of 3 consecutive patients undergoing this technique for benign multinodular goiter disease.
  
  
  METHODS
  Three consecutive patients with large multinodular goiter (>6 cm) were treated using a transaxillary endoscopic approach.
  
  
  RESULTS
  All patients had successful endoscopic thyroidectomy using a transaxillary endoscopic approach. There were no recurrent nerve injuries. One patient had transient hypoparathyroidism that subsequently resolved after surgery.
  
  
  CONCLUSIONS
  Transaxillary endoscopic thyroidectomy may be a viable option to open cervical thyroidectomy in the treatment of patients with large multinodular goiter. We herein present a case report of 3 consecutive patients undergoing this technique for benign multinodular goiter disease.
authors.affiliation: Department of Surgery, Morehouse School of Medicine, Atlanta, Georgia, USA. titusduncan@gmail.com
authors.forename: Titus D
authors.initials: TD
authors.lastname: Duncan
authors.forename: Qammar N
authors.initials: QN
authors.lastname: Rashid
authors.forename: Fredne
authors.initials: F
authors.lastname: Speights
mesh_terms: D000328:Adult; D004724:Endoscopy / Q000379:methods*; D005260:Female; D006044:Goiter, Nodular / Q000601:surgery*; D006801:Humans; D008875:Middle Aged; D013965:Thyroidectomy / Q000379:methods*